Orthopedic device for treating complications of the hip

ABSTRACT

An orthopedic device is provided for treating complications of the hip and has means for trochanter compression, pelvis support, lumbar compression, variously directed straps, and thigh support. The trochanter compression and an internal/external rotation strap provide pain relief through compression and skin protection, unloading of joints through compression and sealing, and unloading by load transfer. Means for adjustably dosing of straps enables pain management and ease of use.

FIELD OF ART

The embodiments of this disclosure are directed to orthopedic devices,particularly to a garment and/or hip orthosis for treating complicationsof the hip and methods for using the same.

BACKGROUND

Conventional hip braces and supports are mainly directed towardspost-operative treatment of arthritis related surgeries (such asarthroplasties and arthroscopies). Few if any braces and supports aredesigned to treat osteoarthritis development or reduce the symptomsrelated to arthritis of the hip.

Braces and supports can assist weak muscles such as gluteus mediusbelieved to be implicated in the sensation of pain. Re-positioning ofthe joint is also considered to be beneficial for other indications,such as anterior-collateral-ligament (ACL) injuries, and may offerimproved control of the knee. One particular group of patients at riskincludes female athletes who experience pain caused by non-contact ACLinjuries because of landing from a jump.

A common problem with landing from a jump is a hyperextended kneeposition regarding the valgus causing internal rotation. It is believedthat the root cause of this problem may be a weak gluteus medius causingthe hip to over-extend and transfer the landing load onto the quadricepsinstead of the gluteus medius. Therefore by flexing, abducting andexternally rotating the hip one may alter the knee position and reducethe load on the ACL when landing from a jump.

Re-positioning or encouraging a preferred position of the hip relativeto the joint may also reduce the load in the medial compartment of theknee and control proper tracking of the patella. Patella pain may becaused by lateral shift. Most patella braces and supports attempt topush the patella medially, however, by rotating the femur externally onemay achieve better results by moving the femur relative to the patellainstead of trying to push straight on the patella. It is known that themedial compartment loading for a patient having osteoarthritis is linkedto the adduction moment of the knee.

It is more recently understood the medial compartment load is alsolinked to the knee extension moment. By rotating the femur externally,one may create a “toe-out” gait shown to reduce the load on thequadriceps and may directly reduce the load on the medial compartment.

Hip orthoses may be used for preventing hip dislocation, and provideearly mobilization after hip surgery while minimizing post-surgicalcomplications. Certain surgical operations include hip jointreplacements or complete or partial revision surgery, and hiparthroscopy. These orthoses can reduce the length of hospitalization andrehabilitation, and the total period for convalescence. Hip orthoses mayalso treat persistent hip pain and non-operable hip deformities.

Prophylaxis or hip dislocation is a problem that occurs when the femoralhead is displaced in the acetabulum or the hip socket. Typically, afterhip surgery, a hip orthosis is needed for immobilization and support toaid in rehabilitation by preventing such a dislocation again.

The head of the femur meets the pelvis at the acetabulum and forms thehip joint. The head of the femur (“femoral head”) and the acetabulumform as a ball-and-socket joint that allows for flexion, extension,abduction, adduction and circumduction. The hip is arranged for weightbearing, and there are connective ligaments for supporting the hipjoint. The trochanter of the femur is located generally opposite thefemoral head, and includes a lateral surface that serves at theinsertion of the tendon of the gluteus medius.

Known hip orthoses used to prevent hip dislocation typically may have anadjustable hinge, which only allows for rotation of the upper leg aboutthe hip joint in forward and backward directions. These hip orthoseshave the drawback of failing to provide a dynamic abducting force on theleg throughout an entire range of motion. The abducting force may beprovided while standing, but is not applied when sitting. Because theconventional orthoses hold the leg in abduction rigidly, this may leadto abnormal gait patterns and compliance issues.

Like other joints, hips may develop osteoarthritis of the hip as thearticular cartilage between the femoral head and the acetabulum breaksdown. The breakdown of the cartilage causes pain, swelling anddeformity. As a result of the osteoarthritis, a patient havingosteoarthritis of the hip may have difficulty walking. Whileosteoarthritis cannot be reversed, nonsurgical treatment may involverest, anti-inflammatories and/or weight loss. If one has later stages ofosteoarthritis of the hip, one may undergo total hip replacementsurgery.

The wear of cartilage is particularly troublesome when loads are placedon the hip. Although there are plenty of solutions for treatingosteoarthritis of the knee, few, if any, braces and supports have beenoffered to successfully treat hip osteoarthritis, specifically forreducing a load on the hip. Thus, there is a need and demand for anorthopedic device arranged for treating hip osteoarthritis.

Another concern regarding complications of the hip and associatedvertebral column involves pelvic tilt and lordosis. Pelvic tilt refersto the orientation of the pelvis in regard to the femurs its rests uponand in space. There are various forms of pelvic tilt including anteriorpelvic tilt result in front tilt and rear rising of the pelvis when hipflexors shorten and hip extensors lengthen, and posterior pelvic tiltinvolving front rise and rear tilt of the pelvis when hip flexorslengthen and the hip extensors shorten. Lateral pelvic tilt describestilting in both directions.

Lordosis is often associated with pelvic tilt, and is the inwardcurvature of the lumbar and cervical vertrebral column. A major factorof lordosis is anterior pelvic tilt, which results in the pelvis tippingforward when resting on top of the femurs. A variety of healthconditions can cause lordosis and include imbalances in muscle strengthand length such as in the hamstrings and hip extensors and flexors.

Another spinal disorder is spinal stenosis, which involves the abnormalnarrowing of the spinal canal. One form of spinal stenosis is lumbarspinal stenosis that occurs at the lower back. In lumbar stenosis, thespinal nerve roots in the lower back are compressed which can lead tosymptoms of sciatica. Sciatica refers to tingling, weakness or numbnessradiating from the lower back and into the buttocks and lower legs.

A variety of solutions exist for treatment of excessive pelvic tilt,lordosis and spinal stenosis of the lower back, however rare aresolutions including orthopedic devices capable of treating both the hipand these aforementioned disorders.

SUMMARY

The orthopedic devices described are designed to reduce the load on thehip joint and encourage a positional shift of the joint believed toreduce pain by guiding the hip away from areas having worn or damagedcartilage. With mobility improved or restored, a user can engage invarious activities without limitations of a constantly painful hip.Increased mobility helps avoid weight gain that may exacerbate symptomsof osteoarthritis of the hip.

According to a preferred embodiment, the orthopedic device is a garmentand/or hip orthosis for treating complications of the hip. The garmentand/or hip orthosis may provide means for trochanter compression, pelvissupport, lumbar compression, variously directed straps, and thighsupport. The trochanter compression and internal/external rotation strapprovide pain relief through compression and skin protection, unloadingof joints through compression and sealing, and unloading by loadtransfer. Adjustable dosing of straps enables pain management and easeof use. Reduced pelvis drop is allowed on the contralateral side by thepelvis support. The lumbar compression increases stability and support.Thigh support with a dosing system provides easy and consistent use foranchoring the orthopedic device on the leg, and hip adduction whenrequired.

The garment (for example, a pair of tights extending over the waist andat least the upper leg) according to this disclosure may protect primaryarthroplasty patients at risk of dislocation, hip revision, recurrentdislocations, and inoperable hip abnormalities or for preventative usein everyday living. Certain embodiments may also treat osteoarthritis ofthe hip, pelvic tilt, lordosis and spinal stenosis.

Embodiments of the garment described secure and control the femoral headin the acetabulum by providing a dynamic force on the leg and hip socketto prevent dislocation and treat instances of osteoarthritis. Forces maybe exerted on the trochanter to urge the femoral head into theacetabulum.

The garment allows the user freedom of movement since the upper leg canmove in all directions and not only in one direction while a desiredinterplay of forces can continue to act on the hip. This offers morecomfort and the possibility of more efficient exercise of the musclesaround the hip joint, which muscles may be weakened due to surgery.

In a first embodiment, the garment includes an upper belt member or beltand a lower wrap securing about the knee and/or thigh to position andanchor garment onto a user's body. A plurality of straps is arranged onthe garment in a plurality of orientations to provide differentdirectional forces over the user. The straps may be detachable andattachable at a plurality of predetermined locations. The straps may bealso semi-elastic to encourage certain movements through theirelasticity and softly prevent certain movements through theirresistance. The prevention of movement is neither rigid nor stopsmovement but rather provides feedback and inhibits certain movement.

The straps can be integrated into a garment. The functionality from thestraps can be achieved using textile patterns where portions of thetextile will have different elastic properties providing feedback, orstraps integrated into the garment separately adjustable using hook andloop or other tightening methods. The straps may extend at least in partthrough various sleeves formed on the garment to control movement. Thesleeves may be formed from inelastic material to stabilize the strapsand provide additional support while not inhibiting the elasticity ofthe straps.

The straps are preferably anchored at a first end to the garment andmovably adjustable at a second, free end at various locations on thegarment according to the tension and anatomy of the user.

A flexion strap may be attached to the anterior portion of the belt andanterior portion of the lower wrap. The strap encourages flexion andprevents extension of the hip. An abduction strap may be attached to thelateral portion of the upper belt member and the lateral portion of thelower wrap. The abduction strap encourages abduction and preventsadduction of the hip.

An exorotational strap may be attached to the lateral side over theposterior of the garment and spirals over the anterior side of the thighand to the medial side towards posterior portion of the lower wrap. Thestrap encourages exorotation of the hip, and prevents endorotation. Thestrap encourages abduction and flexion of the hip, while preventingadduction and extension.

The garment may include a waist strap or belt extending laterally aboutthe pelvis and circumferentially tightening over the trochanter of thefemur to encourage placing or securing the femoral head in the hipsocket. A lower wrap or band may extend laterally near the knee and formpart of the lower wrap to serve as an anchor point for at least theabduction and the exorotational straps. The lower wrap may include firstand second straps extending above and below the knee respectively, orthe lower leg strap may be located singularly either above or below theknee.

The hip orthosis according to this disclosure may protect primaryarthroplasty patients at risk of dislocation, hip revision, recurrentdislocations, and inoperable hip abnormalities or for preventative usein everyday living. Certain embodiments may also treat osteoarthritis ofthe hip. The hip orthosis may form part of the garment and/or be insupplement to the hip garment.

Pain relief is achieved by various embodiments by applying pressure onthe greater trochanter by using a tensioning system, such as apulley-type, to tension the orthosis over the trochanter. The upper partof the garment may be made from a non-stretchable material to bettertransmit the force from the tensioning system to the trochanter area.Using an elastic strap creates rotation of the leg. The upper part ofthe strap is fixed to the back area of the garment. Depending on therequired rotation, internal or external, the strap is taken between thelegs and to the front of the thigh or directly to the front of the thighand then in both cases secured to a lower tightening unit using afastening device. Using a frame fastened to the garment once thetensioning system has been tightened and fully secured creates abductionof the leg.

The orthopedic device, particularly the lumbar support in combination orconsidered alone with the tensioning system, may be used to improveimmobilization of the lower back, by resisting flexion, extension,pelvic tilt, spinal rotation, and lateral bending. Another mechanism ispelvic stabilization in which the lumbar support maintains properalignment of the pelvis in relation to the spine, and reduces pain inthe lumbo-sacral region. Yet another mechanism is hydrostatic lift thatoccurs when the abdominal cavity is gently compressed, and theintra-abdominal pressure is increased. In yet another mechanism, thelumbar support introduces lordosis support or maintains lumbar supportin order to provide correct lumbar lordosis for pain relief, spinalstabilization and improved posture.

The orthopedic device may include a plate system in combination with thetensioning system, or the tensioning system alone whether by placementor structure, may provide lordosis support to exert pressure tointroduce and maintain correct lumbar lordosis for pain relief, spinalstabilization and improved posture such as by decreasing lordosis andincreasing pelvic tit.

Embodiments of the hip orthosis described secure and control the femoralhead in the acetabulum by providing a dynamic force on the leg and hipsocket to prevent dislocation and treat instances of osteoarthritis.This dynamic force mechanism follows the anatomical motion of the hipjoint by maintaining the prescribed flexion and extension restrictions.Forces may be exerted on the trochanter to urge the femoral head intothe acetabulum. Features of the hip orthosis attribute to a more stableand versatile orthosis over conventional braces.

Because of the versatility in sizing of the garment, there is only needfor a few sizes, and a clinician may make further size adjustments bytrimming belt segments and various cables. The garment provides painrelief and comfort through compression and skin protection. The orthosisenables trochanter compression with an optional pad, which allows forpain relief by unloading through compression and sealing, and unloadingby load transfer.

The embodiments may include an internal or external rotation strap thatpermits adjustable dosing for pain management and versatility dependingon whether internal or external rotation control is desired. Theembodiments also allow for pelvis support by inhibiting reduced pelvisdrop on a contralateral side. Lumbar compression is also allowed whichincreases stability and support. Thigh support is achieved with dialtensioning providing easy and consistent use for anchor and effectivehip abduction when required.

The hip orthosis according to this disclosure may protect primaryarthroplasty patients at risk of dislocation, hip revision, recurrentdislocations, and inoperable hip abnormalities or for preventative usein everyday living. Certain embodiments may also treat osteoarthritis ofthe hip.

In an embodiment of the hip orthosis, it may include a spring assemblyfor operatively preventing adduction movement of an upper leg by aspring force. The spring assembly operatively exerts a force and/or amoment on the upper leg which makes the upper leg abduct, viewed fromthe front side of the person, preferably independently of the positionof the upper leg regarding the trunk.

The hip orthosis allows the user freedom of movement since the upper legcan move in all directions and not only in one direction while a desiredinterplay of forces can continue to act on the hip. This offers morecomfort and the possibility of more efficient exercise of the musclesaround the hip joint, which muscles are weakened due to surgery.

In use, the spring assembly exerts a force on the hip joint, such thatthe hip is pressed into its socket under the influence of that force, sothe risk of dislocation is reduced further. The spring assembly alsoexerts a moment on the hip joint. This allows the upper leg to be givena preferred position regarding the trunk and/or to rotate it to apreferred position. The moment is directed so the upper leg is rotatedsubstantially outwards, at least into a direction transverse to thesagittal plane. This prevents excessive abduction of the upper leg(towards the other leg), and reduces the risk of hip dislocation.

Other embodiments of the hip orthosis may be hingedly attached to thegarment, such at a portion located above the knee. The hip orthosis maybe without the spring assembly, but rather include a strut connecting atone end to a trochanter support and another end to the garment above theknee.

From these features, the various embodiments described herein providepain relief, especially for users suffering from superior lateralosteoarthritis. The embodiments are compliant and provide comfort toencourage users to wear the garment throughout the day and preventdiscouragement from wearing the brace. The features of the embodimentsare simple to use, so after the initial fitting, the user does not feelencumbered by adjusting the orthosis. Because of the streamlinedconfiguration of the orthosis, a user may wear it under clothing toavoid public display of its use.

The numerous advantages, features and functions of the embodiments willbecome readily apparent and better understood in view of the followingdescription and accompanying drawings. The following description is notintended to limit the scope of the orthopedic device, but instead merelyprovides exemplary embodiments for ease of understanding.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects, and advantages of the embodimentswill become better understood regarding the following description,appended claims, and accompanying drawings.

FIG. 1 is a perspective front view of an embodiment of a garmentaccording to the disclosure.

FIG. 2 is a perspective rear view of the garment according to FIG. 1.

FIG. 3 is a side view of the garment according to FIG. 1.

FIG. 4 is a detailed lateral side view of the garment according to FIG.1.

FIG. 5 is a detailed medial side view of the garment according to FIG.1.

FIG. 6 is a schematic view of the garment according to FIG. 1 showingthe directional forces created by tensioning various straps.

FIGS. 7A-7C are side, front and rear views of another hip orthosisembodiment according to the disclosure.

FIG. 8 is a schematic view of the hip orthosis of FIGS. 7A-7C with thefirst belt segment open showing a trochanter support.

FIGS. 9A-9B are side and front views showing the hip orthosis of FIG. 1in combination with a compression belt on a user.

FIGS. 10A-10B are side and front views showing another hip orthosisembodiment according to the disclosure.

FIG. 11A is a front view showing another hip orthosis embodimentaccording to the disclosure.

FIG. 11B is a schematic view showing opening of the hip orthosis of FIG.11A and installation of a trochanter pad.

FIG. 12 is a rear view showing the hip orthosis of FIG. 11A.

FIG. 13 is a detailed view showing a rear view of the compression systemwithout a cover.

FIG. 14 is a detailed view of a set of pulleys in the compression systemin the hip orthosis of FIG. 11A.

FIG. 15 is a schematic view of a buckle assembly in the hip orthosis ofFIG. 11A.

FIG. 16 is a detailed view of the lower support in the hip orthosis ofFIG. 11A.

FIG. 17 is a schematic view of the lower support in FIG. 16 andattachment of straps.

FIG. 18A is a plan view of a support element in the lower support ofFIG. 17.

FIG. 18B is a front view of a strap of the lower support in FIG. 17.

FIG. 19 is a perspective view of another hip orthosis embodimentaccording to the disclosure.

FIGS. 20-22 are rear, front and side views of the hip orthosisembodiment of FIG. 19.

FIG. 23 exemplifies views of another hip orthosis embodiment accordingto the disclosure.

FIG. 24 includes schematic views showing a hip orthosis embodimentarranged for derotational strapping in a hip.

FIG. 25 includes schematic views showing another hip orthosis embodimentarranged for derotational strapping in a hip.

FIG. 26 includes schematic views showing another hip orthosis embodimentarrangement for rotational strapping in a hip.

FIGS. 27 and 28 disclose frontal and rear views of a strut assembly foruse with embodiments described herein.

FIG. 29 is a schematic view of a length adjustment assembly fortensioning devices.

FIG. 30 is a perspective of an embodiment of a hip orthosis according tothe disclosure.

FIG. 31A is a perspective view of an adjustment assembly of the hiporthosis according to FIG. 30.

FIG. 31B is another perspective view of the adjustment assembly of thehip orthosis according to FIG. 30.

FIG. 32 is a detailed sectional side view showing an upper portion ofthe hip orthosis according to FIG. 30.

FIG. 33 is a detailed view showing adjustment of the pivot adjustmentmechanism in the hip orthosis according to FIG. 30.

FIG. 34 is a detailed view showing adjustment of the pressure adjustmentmechanism in the hip orthosis according to FIG. 30.

FIG. 35 is a detailed sectional rear view showing a lower portion of thehip orthosis according to FIG. 30.

FIG. 36 is schematic view showing another embodiment of the orthopedicdevice.

FIG. 37 is a perspective view showing a frame assembly in the orthopedicdevice of FIG. 36.

In the various figures, similar elements are provided with similarreference numbers. The drawing figures are not drawn to scale, orproportion, but instead are drawn to provide a better understanding ofthe components, and are not intended to be limiting in scope, but ratherprovide exemplary illustrations.

DETAILED DESCRIPTION OF VARIOUS EMBODIMENTS

A. Overview

While the disclosure is susceptible to various modifications andalternative constructions, certain illustrative embodiments are in thedrawings and are described below. It should be understood, however,there is no intention to limit the disclosure to the specificembodiments disclosed, but on the contrary, the intention covers allmodifications, alternative constructions, combinations, and equivalentsfalling within the spirit and scope of the disclosure.

B. Environment and Context of Embodiments

For further ease of understanding the embodiments of an orthopedicdevice in the exemplary form of a garment and/or hip orthosis fortreating complications of the hip and variants as disclosed, adescription of a few terms is necessary.

The terms “rigid,” “flexible,” “compliant,” and “resilient” maydistinguish characteristics of portions of certain features of thestraps and garment. The term “rigid” should denote an element of thedevice is generally devoid of flexibility. Within the context offeatures that are “rigid,” it is intended to indicate that they do notlose their overall shape when force is applied, and may break if bentwith sufficient force. The term “flexible” should denote that featuresare capable of repeated bending such that the features may be bent intoretained shapes or the features do not retain a general shape, butcontinuously deform when force is applied.

The term “compliant” may qualify such flexible features as generallyconforming to the shape of another object when placed in contacttherewith, via any suitable natural or applied forces, such asgravitational forces, or forces applied by external mechanisms, forexample, strap mechanisms. The term “resilient” may qualify suchflexible features as generally returning to an initial general shapewithout permanent deformation. As for the term “semi-rigid,” this termmay be used to connote properties of support members or shells thatprovide support and are freestanding; however such support members orshells may have some degree of flexibility or resiliency. The term“elastic” may connote stretchability, and the term “semi-elastic”connotes various degrees of elasticity as compared to the term“inelastic” which may mean devoid or substantially devoid of anyelasticity.

The embodiments of the disclosure are adapted for a human body, and maybe dimensioned to accommodate different types, shapes and sizes of humanbody sizes and contours. For explanatory purposes, the orthopedic deviceembodiments described are referred to as corresponding to differentsections of a body and are denoted by general anatomical terms for thehuman body.

For explanatory purposes, each orthopedic brace embodiment or componentdescribed may be divided into sections denoted by general anatomicalterms for the human body. Such anatomical terms are provided todistinguish various elements of the brace embodiments from one another,but which are not to be considered to limit the scope of the invention.

Each of these terms is used in reference to a human leg, for example,which is divided in similar sections with a proximal-distal planeextending along the meniscus of the knee between the femur and tibia.The terms “proximal” and “distal” refer to locations of the brace thatcorrespond to the location of the leg relative to the point ofattachment of the leg to the body. The terms “upper” and “lower” may beused in combination with “proximal” and “distal” to connote gradationsin location of “proximal” and “distal.” The location at where the bracecorresponds to the knee joint is used to generally delimit the proximaland distal sections of the brace.

The embodiments of the orthopedic device can also be considered to fallwithin “anterior” and “posterior” sections by an anterior-posteriorplane. The anterior-posterior plane generally corresponds to the coronalor frontal plane of a human leg lying along the central longitudinalaxis of a body. A posterior side or element is therefore located behindthis anterior-posterior plane, whereas an anterior side or element is infront of the anterior-posterior plane.

The terms “inwardly” or “inner” commonly used to distinguish the side ofthe brace may be directed to the posterior side of the brace andadjacent to the leg of the user of the brace. Contrariwise, the terms“outwardly” or “outer” are used to denote the side of the brace oppositeto the inwardly side.

The terms “medial” and “lateral” are relative terms generally understoodas indicating location near the midsaggital plane or midline. Therefore,elements located near the midline are referred to as “medial” and thoseelements further from the midline are “lateral.” The term “central” isused to denote the area along the midline of a joint dividing andsharing regions of the medial and lateral regions.

The term “adduction” is defined as being a movement towards the trunk.The term “abduction” is defined as being a movement by which a body partis moved away from the axis of the body.

The hip region is commonly considered as being located lateral to thegluteal region (i.e. the buttock), inferior to the iliac crest, andoverlying the greater trochanter of the femur, or “thigh bone”. Inadults, three of the bones of the pelvis have fused into the hip bonethat forms part of the hip region.

The hip joint, scientifically referred to as the acetabulofemoral joint,is the joint between the femur and acetabulum of the pelvis and itsprimary function is to support the weight of the body in both static(e.g. standing) and dynamic (e.g. walking or running) postures. Thepelvic inclination angle, which is the single most important element ofhuman body posture, is adjusted at the hips.

The pelvis is referred to as either the lower part of the trunk, betweenthe abdomen and the thighs (sometimes also called pelvic region of thetrunk), or the skeleton embedded in it (sometimes also called bonypelvis, or pelvic skeleton). The pelvic region of the trunk includes thebony pelvis, the pelvic cavity (the space enclosed by the bony pelvis),the pelvic floor, below the pelvic cavity, and the perineum, below thepelvic floor. The pelvic skeleton is formed in the area of the back, bythe sacrum and the coccyx and anteriorly and to the left and rightsides, by a pair of hip bones. The two hip bones connect the spine withthe lower limbs. They are attached to the sacrum posteriorly, connectedto each other anteriorly, and joined with the two femurs at the hipjoints.

The waist or waist region is the part of the abdomen between the ribcage and the hips, and is often the narrowest part of the torso onproportionate people. The thigh or thigh region is considered the areabetween the pelvis and the knee.

The term “adduction” is defined as being a movement towards the trunk.The term “abduction” is defined as being a movement by which a body partis moved away from the axis of the body.

C. Various Embodiments of the Orthopedic Brace and Components for UseTherewith

In reference to FIGS. 1-5, a garment 10 for treating complications ofthe hip is illustrated. The garment includes an upper wrap 12 in a belt,a main body portion 14 extending over the thighs, and a lower band orwrap 16 located near the knees K. The upper and lower wraps 12, 16 serveas anchors to securing the garment on the user, and likewise for variousstraps attached to the garment. The lower wrap 16 may be secured belowor above the knee, or both.

The belt 12 is attached around the user's pelvis/waist, anatomicallyshaped, and tightened using hook and loop, buckles or other fastenermeans. The belt 12 includes first and second belt segments arranged tooverlap and secure to one another. By circumferentially compressing overthe user's waist, the belt forms an upper anchor to the garment.

The belt 12 is preferably formed from a stretchable and compressiblematerial arranged to extend over the user's waist and pelvis. The beltcan have silicone patches integrated into the textile that creates africtional interface to the skin or the user's undergarments to reducemigration, as shown in FIG. 6 under reference 46. The belt can bearranged with a tensioning or pulley system similar to a lumbar beltdiscussed in U.S. Pat. No. 8,172,779, granted on May 8, 2012, andincorporated by reference. The embodiments are not limited to pulleysand may include posts, sliders or other means for providing mechanicaladvantage for a cable. Alternatively, the tensioning system may be aplurality of straps replacing pulleys, cables and similar means.

A lateral strap 18 may be secured at a first end to the posterior of thegarment and extend about the user's pelvis. The lateral strap 18 has asecond end adjustably attachable to the garment. The lateral strap 18 isintended to provide localized and enhanced pressure over the user'strochanter to maintain the femoral head in the user's socket.

The body portion 14 may be formed from a generally sturdy fabric elasticmaterial, such as Lycra or Spandex. The body portion 14 is configured toconform to the legs of the user and provide an interface over which thestraps extend.

The lower wrap 16 may form a knee/thigh wrap anatomically shaped to sliponto the leg. The wrap can be solely around the thigh, or extend downbelow the patella. The knee/thigh wrap can have a hole for the patella,and include straps in the bottom, middle or top portion that allows fortightening to avoid migration. The wrap can also have integratedsilicone patches, as discussed in connection with the upper wrap, toprovide frictional resistance.

In the embodiments of FIGS. 2-5, the lower wrap 16 is arranged as alateral strap extending adjacent to and below the user's knee. The lowerwrap 16 forms a lower anchor to the garment, and prevents migration ofthe garment on the lower leg. In this configuration, the lower wrap 16forms a gastroc strap that corresponds to the gastroc and secures thebrace in place between the knee and the user's calf by the shape of theuser's calf to inhibit migration. Alternatively, the lower wrap 16 maybe located so it extends adjacent to and above the user's knee.

The lower wrap 16 may include a lower strap 32 allowing for tensioningof the lower wrap 16 over the leg. The lower wrap 16 may define anelasticized portion of the garment 10 having a channel through which thelower strap 32 extends. The lower wrap 16 is yet further tightened overthe user's leg by adjustment of the elastic strap 32 relative to thechannel. The lower strap 32 may be inelastic or elastic.

In a variation of the lower wrap 16 depicted in FIG. 1, the lower wrap16 includes an upper circumferential strap 40 arranged to extend aboutthe lower thigh above the knee, and a lower circumferential strap 50arranged to extend about the lower leg below the knee. Medial andlateral elongate straps 42, 44 extend transversely relative to andconnect the upper and lower circumferential straps 40, 50 to keep themsecured to one another.

A longitudinal band or abduction strap 20 extends longitudinally alongthe lateral side of the garment, and is arranged to encourage abductionand prevents adduction of the hip. The abduction strap 20 is anchored atpoint 34 above the lower wrap 16, and is adapted to extend to the upperwrap 12 so a free end 28 secures to the upper wrap 12.

The body 14 may define a sleeve 24 having an opening 36 through whichthe abduction strap 20 extends from the lower wrap 16 to the upper wrap12. The sleeve 24 has a greater width than the abduction strap 20 topermit adjustment of the abduction strap 20 relative to the sleeve 24.The sleeve 24 may be formed at least in part from a material inelasticto stabilize and support the area of the leg corresponding to the sleeve24.

An oblique band or exorotational strap 22 extends from an anchor pointat the posterior of the leg wrap 16 and spirals toward the medialposterior of the leg, over the anterior thigh and has a free end 26securable to the posterior lateral side near or at the upper wrap. Theexorotational strap 22 extends through a channel 30 formed from thelower wrap to a location on the anterior side of the garment. Thechannel 30 is wider than the exorotational strap 22 and is formed atleast in part from a material inelastic to stabilize and support theexorotational strap 22 over the leg. The channel 30 assists indistributing pressure over the leg.

The garment 10 may be provided with a flexion strap 38 arranged from thelower wrap 16 and securing to the upper wrap 12 along the anterior ofthe garment generally along the midline. The flexion strap encouragesflexion and prevents extension of the hip.

In a variation, the garment may be provided with an extension straparranged on the posterior of the garment generally along the midline.The extension strap encourages extension and resists flexion.

FIG. 6 depicts various forces incurred by the various straps. Thelateral strap 18 provides a circumferential force F1 about the pelvis toapply to the trochanter. The abduction strap 20 provides an upwardlyforce F2 from the knee to the pelvic to prevent adduction of a user'sleg. The exorotational strap 22 provides a spiraling force F3 generallyoblique to the forces F1, F2, to encourage abduction and thereforeresist adduction. The lower strap 16 provides a circumferential force F4to anchor a lower portion of the garment.

As shown in FIGS. 7A-7C, another embodiment of a hip orthosis includes apelvic compression support 100 adapted to be secured about the user atthe pelvis. This arrangement is distinguishable from a lumbarcompression support discussed in U.S. Pat. No. 8,172,779 provided aboutthe waist and intended to provide compression to the lumbar area of theuser. The pelvic compression support 100 has a more significant width112 than a conventional lumbar support, and is arranged to sit over thehips including the trochanter resting at least partially below a lumbarregion of the user's back unlike the conventional lumbar support.

The pelvic compression support 100 includes first and second beltsegments 102, 104 extending from a rear or posterior compression system106 discussed more fully in U.S. Pat. No. 8,172,779. Tensioning devices108, 110 extend from the compression system 106, and are intended toprovide compressive adjustment to the rear compression system 106 andsecure over the first and second belt segments 102, 104. Multipletensioning devices may be provided on each side of the compressionsystem. Each side may include upper and lower tensioning devices eachselectively adjusting various locations of the compression system.

FIG. 8 shows a trochanter support 114 located underneath the first beltsegment 104, and adjacent the user's body. As the first and second beltsegments 102, 104 are secured to one another, and the tensioning devices108, 110 are used to tension the rear compression system, compressivesupport is provided particularly at the trochanter support 114, whichurges the femoral head into the hip socket (acetabular) to providerelief to the user. The garment may be provided with inelastic fabricthat is hook receivable to include a trochanter pad carried by thetrochanter support.

FIGS. 9A and 9B show the hip orthosis of FIG. 1 in combination with acompression belt or upper wrap 150. Unlike the compression belt of FIGS.7A-7C, the compression belt 150 sits higher toward the waist of the userby a difference 156, and has a narrower width 158.

In this embodiment, the pelvic support 12 is located adjacent the userand underneath a first belt segment 152 which secures to a second beltsegment 154. A pad 70 covering at least part of the pelvic support 12may be retained by the pelvic support 12 to the first belt segment 152.

An exorotation strap 71 secures to a strut assembly 121 at an upperanchor 78 and wraps around the leg and secures to a lower anchor 80 onthe lower support 16. The exorotation strap 71 defines a first segment72 depending from the upper anchor 78 and couples to a second segment 74by a tensioning device 76 providing incremental tensioning of theexorotation strap 71. The tensioning device 76 may correspond to thestrap tightener assembly for an orthopedic device according to U.S.application Ser. No. 13/739,491, filed on Jan. 11, 2013 and published asU.S. patent application publication 2013/01846628 A1 on Jul. 18, 2013.Alternatively, the exorotation strap 71A (shown in dashed lines) may rununderneath the strut assembly 121 and secure to the posterior side ofthe upper wrap 150.

The strut assembly 121 includes a strut 123 connecting to the lower wrap16 and the pelvic support 12. The strut may carry a trochanter support114, and a strut adjustment or pivot mechanism 35 may adjust position ofthe trochanter, as discussed more fully regarding the strut assembly ofFIG. 30.

FIGS. 10A-10B show another embodiment of a hip orthosis employing thecompression belt 150 of FIGS. 9A-9B and the exorotation strap 71attached directly to a generally posterior side of the compression belt150 on a lateral side of the leg. The tensioning device 76 is secureddirectly to the compression belt and allows for adjustment of theexorotation strap 71. The tensioning device 76 allows for tensioning ofthe second strap segment 74, which couples to the lower support 16. Astrap support 82 may be in combination with the exorotation strap 71 todistribute pressure over the thigh.

Referring to the embodiment of FIGS. 11A-18, the orthopedic device 200combines a garment and hip orthosis and includes first and second upperbelt members 202, 204 adapted to wrap about a user's hip. A waist band211 is located at a generally uppermost portion of the orthopedicdevice, and is adapted to secure to the waist of the user. Lower bands213 are located at generally lowermost portions of the orthopedicdevice, and the inside surface of the lower bands 213 may include africtional interface to engage the skin and prevent migration of thegarment on the user.

The upper belt members 202, 204 having posterior or lateral ends thatare joined to the garment 216 on the lateral and/or posterior sides ofthe orthosis by a joint 244 such as permanently by stitching orremovably by hook and loop fastening. The upper belt members 202, 204freely extend from the joint or stitching, and have anterior ends thatare secured to one another by a buckle assembly 205. The anterior endsof the upper belt members have trimmable sections 207 bordered by trimlines allowing for sizing of the upper belt members to the specificdimensions of an individual user. The trim lines may be reducedthickness regions of the upper belt members.

The shape of the anterior side of the belt members is significant inthat it extends more substantially toward the upper portion of thegarment, although preferably at its greatest slight below, as shown inFIG. 11A, and tapers in the extent it extends anteriorly toward thelower portion of the garment. The height of the belt members ispreferably at its greatest at the joint to distribute forces createdwhen the belt members are secured to one another. The tapering height ofthe belt members tracks generally the anatomy of the pelvic region ofthe user so that the anterior-most portion does not interfere withnormal activities.

The garment 216 may include different sections having differentstretchability, stiffness, or carry various surface textures forsecuring to various straps. Lateral portions 238 may have a stifferproperty than portions 240 outside of the lateral portions 238. Thelateral portions may be reinforced or possess the stiffer properties toprovide additional resistance for controlling movement of the hip andlegs. The lateral portions may also be substantially inelastic ascompared to other portions of the garment outside the lateral portions.

FIG. 11B shows insertion of a trochanter pad 267 along an inner surfaceof the upper belt member 206. The trochanter pad 267 may be removablysecured along the inner surface by a hook and look system, whereby thetrochanter pad 267 includes a hook material segment arranged to securedto loop material formed along the inner surface. The trochanter pad 267may have a pocket 269 arranged for receiving a frame element of a strutassembly, as discussed herein.

Observing FIGS. 11A and 15, the buckle assembly 205 includes first andsecond segments 206, 208 depending from the first and second beltmembers 202, 204. The first and second segments may be trimmable to sizeaccording to an individual user, and may be elastic or inelastic. Thefirst and second segments 206, 208 may comprise “alligator” type hookclamps forming opposed hook surfaces arranged to clamp onto a hookreceivable surface of the first and belt members.

The first segment 206 carries a tab 210 having a catch 258, such as apin or other protrusion, adapted to be received by a clip 212 carried bythe second segment 208, thereby forming a buckle. The clip 212 maydefine a plurality of engagement openings 260, 262 for receiving andallowing the catch 258 to engage with the clip 212.

Each of the engagement openings 260, 262 is sized and configured forquick attachment of the catch 258. In the depicted embodiment, a largeropening 261 permits insertion of the catch 258 therethrough and asmaller opening 263 continuously depends from the larger opening 261 sothe tab 210 can be pulled toward an end of the clip 212 to firmly engagethe catch 258 within the smaller opening 263.

The orthosis 200 includes tensioning devices 214A-214D arranged fortensioning a compression system 229, and arranged to function similarlyto the compression system in the embodiment of FIGS. 7A and 7B.Tensioning devices 214A and 214B correspond to the first belt member 202and tensioning devices 214C and 214D correspond to the second beltmember 204. Handles 264 of the tensioning devices are secured to theupper belt members, which may bear hook receivable material, and thehandles themselves may carry hook material. As the compression system229 is arranged on the posterior of the hip orthosis 200, the tensioningdevices extend freely from the compression system 229 and pulling of thetensioning devices from the compression system 229 tensions thecompression system over the pelvis.

As shown in FIGS. 13 and 14, the compression system 229 includes aplurality of tensioning sets such as those including pulleys 242A-242Dcorresponding to the tensioning devices 214A-214D. The pulley setsfunction in a manner similarly as the pulley sets described in U.S. Pat.No. 8,172,779, in that the pulley sets include pulleys 248 correspondingto each tensioning device 214A-214D, and anchors 250 for each tensioningdevice. A cover 231 may be provided to cover the compression system 229.

In this embodiment, as the first and second belt members 202, 204 may bestitched at their posterior ends to the garment 216 by the joint 244,the distance between the pulley sets 242A-242D is adjustable to providetension on the pelvis. The stitching occurs along a plurality ofopenings 246 formed along a tab of the pulley sets such that the beltmembers extend toward the anterior side of the garment from the jointand the tensioning sets extend toward one another posteriorly from thejoint. The belt members and the tensioning sets preferably are arrangedto counteract one another.

An oblique band or exorotation strap 217 secures at one end to an anchor230 protruding from the pulley sets. The upper belt members 202, 204 mayeach define an opening 236, 238 through which the exorotation strap 217can secure so as not to interfere with operation of the belt members202, 204, and the exorotation strap 217.

The exorotation strap 217 may include a tab 228 having means such as akeyhole to secure to the anchor 230. As with the embodiment of FIGS. 9Aand 9B, the exorotation strap 217 defines a first segment 218 dependingfrom the upper anchor 230 and couples to a second segment 232 by atensioning device 220 and indicia sleeve 222 which provides incrementaltensioning of the exorotation strap 217.

The exorotation strap may be arranged on the leg in differentorientations depending on the desired rotation, internal or external.The strap is either taken between the legs and to the front of the thighor directly to the front of the thigh or then in fastened to a lowerportion of the garment.

Referring to FIGS. 11A, 12 and 16, a lower tightening unit or wrap 226includes a junction 227 for receiving the second segment 232 of theexorotation strap 217 and carries a dial tensioning unit 224 foradjusting the tightness in the lower wrap 226. In the illustratedembodiment of FIG. 16, the lower wrap 226 has a strap 252 with opposedends connected to locking elements or buckles 254, 256 enabling quickattachment to secure the lower wrap onto the leg. The locking elements254, 256 may secure about the junction 227 with the second segment ofthe exorotation strap.

Referring to the embodiment of FIGS. 17 and 18A, the lower wrap 226includes an elongate tab 264 carrying an anchor point 268 and replacingthe buckle 254 in FIG. 16. The anchor point 268 is used to secure to thelocking element 256 carried by a second end of the strap 252, whereasthe tab 264 connects to a first end of the strap 252. The tab 264includes another anchor 266 extending along a rear portion of the taband adapted to secure to a locking element 272 carried by the secondsegment 232 of the exorotation strap.

The tab 264 carries a dial tensioning device 224 coupled to a cablesystem 269 securing to the first end of the strap 252. The dialtensioning device 224 allows for fine adjustment of the tensioning ofthe strap 252.

The exorotation strap may be formed from an elastic or inelasticmaterial. In the depicted embodiments, the exorotation strap is elastic.The exorotation strap is preferably trimmable in length at both ends forcorrect placement of the tensioning device over the user's leg. Theexorotation strap may removably secure to the tensioning device 220 andthe lower wrap 226 by means such as “alligator” type hook clamps and/orwith keyhole connections. A pad may be on a body facing surface of theindicia sleeve 222 to provide for improved comfort.

The lower wrap strap 252 is preferably an elastic strap for improvedcomfort. Alternatively, the lower wrap strap may be inelastic orelastic, and formed from a loop material/foam material/loop materiallaminate.

FIG. 18B shows the strap 252 as having an elastic segment 263 with aninelastic segment 259 located at a first end carrying the lockingelement 256 with a keyhole 257. The strap 252 includes a sleeve 265extending over a second end of the strap carrying the dial-tensioningdevice 224. The second end of the strap carries the anchor point 268,which is arranged to couple with the locking element 256 on the secondend. The second end, by the dial tensioning device features or otherwisemay be inelastic so the elasticity of the strap 252 is confined by theelastic segment 263, which provides comfort to the user. Of course othercombinations of elastic and inelastic segments may be envisioned for thestrap.

Any of the orthopedic device embodiments may be provided with a platesystem arranged for securing against at least the lumbar region and/orabdomen of the user. Various back plate systems useable with theorthopedic device embodiments may be found in U.S. Pat. No. 8,172,779.The difference from the lumbar-sacaral orthosis in U.S. Pat. No.8,172,729 is that the orthosis in such patent is arranged as a lumbarbelt whereas the embodiments described herein are arranged for the hipand pelvis. The embodiments herein may be configured with at least ahigher posterior portion to accommodate a plate system or have aconnection for plate system to extend above the orthopedic device forplacement against a lumbar region if the orthopedic device is configuredfor securing below such region.

For example, a back plate may slidably connect to the posterior portionof the orthopedic device. According to this embodiment, the back plateis flexible or bendable to accommodate the anatomy of a wearer's backwhen the closure system is employed. The ability to bend about thewearer's back is particularly advantageous since the back plate can beused to support a variety of anatomical contours of a single wearer or avariety of wearers. However, while the back plate is bendable about thewearer's back, it provides sufficient rigidity to support thelumbo-sacral region of the wearer. In an alternative, the back plate maybe custom formed so as to correspond to exact contours of a particularwearer wherein the back plate is substantially rigid or semi-rigid.

The back plate of the plate system may have a particular anatomicalgeometry that is arranged to closely accommodate a wide variety ofdifferent back anatomies. For example, the plate may be configured torelieve pressure over a spinal region of a human back by having anoutwardly directed curvature generally protruding away from the spinalregion. The plate may be arranged to apply even pressure over aparaspinal musculature of a human back by having an inwardly directedcontour extending over the paraspinal musculature. The plate may includeside wing portions which are inwardly contoured toward the wearer, atapered top portion and generally rounded side portions, which providecoverage over side portions of the lumbar region of a wearer's back, andcontribute to better pressure distribution over sensitive and lesssensitive areas of a wearer's back.

The plate may define a general arcuate contour providing lordosissupport for the wearer. This contour, in combination with pressureexerted on the plate via the closure system, introduces and maintainscorrect lumbar lordosis for pain relief, spinal stabilization andimproved posture, such for decreasing lordosis and increasing pelvictilt. Because the plate is anatomically contoured with theaforementioned features, better hydrostatic lift is also created whenthe abdominal cavity is gently compressed and the intra-abdominalpressure is increased.

As discussed in U.S. Pat. No. 8,172,729, the anatomical shape of theplate creates better pelvic stabilization since it is arranged toproperly align the pelvis in relation to the spine, thereby reducingpain in the lumbo-sacral region of a wearer's back. Again, incombination with closure system, the plate allows for improvedimmobilization of a wearer's back by immobilizing flexion, extension,pelvic tilt, spinal rotation and lateral bending.

Referring to FIGS. 19-22, a hip orthosis 300 embodiments is shownwherein exorotational straps 302, 304 are arranged in a neutralconfiguration to keep the hip in neutral position and to restrict bothinternal and external rotation. Both upper ends of the exorotationalstraps 302, 304 are secured to an upper anchor point 306 on thecompression system and to a lower anchor point 308 on the lower wrap314.

FIGS. 19-22 exemplify how the exorotational straps 302, 304 may beanchored to the belt member 310 with a tensioning system and the lowerwrap 314 without the necessity of a garment, as described in variousembodiments herein. The upper and lower wraps 310, 314 may be connectedwith an elongate lateral segment 312 which may include a strut assembly.

FIG. 23 shows an embodiment without a belt member, rather the embodimentincludes a garment 320 on which the exorotation strap 322, 324 securesto a posterior portion or panel 326 and a lower wrap 328 of theembodiments described herein. In this embodiment, exorotation straps areon both legs for stabilization of both hips.

FIG. 24 exemplifies an embodiment in which the strap providesderotational strapping in the hip. In the configuration in FIG. 24,there is minimal rotation, minimal abduction and little or no flexionresistance or assistance. The strap 340 includes a lower wrap 342 havingportions that may extend above and below the knee to anchor the strap340. A rotational strap 344 extends from the medial side of the lowerwrap and spirals along the medial leg and over the buttocks to an upperbelt member 346 at about a frontal or anterior portion of the hipgenerally between the lateral and medial sides.

FIG. 25 offers another configuration of the strap 340 including thelower wrap 342 and the rotational strap 344 in the embodiment of FIG.24. Similarly to the embodiment of FIG. 24, the rotational strap 344extends from the medial side of the lower wrap 342 and spirals along themedial leg and over the buttocks. Unlike in the configuration of FIG.24, the rotational strap 344 is secured to a lateral side of the upperbelt member 346. In this configuration, there is internal rotational andabduction control, and flexion and resistance and extension assistance.

Referring to the embodiment of FIG. 26, a variation of the hip orthosisof FIGS. 10A-10B or FIGS. 24-25 is employed in combination with aderotational strap 350. The derotational strap 350 secured to the lowerwrap 342. In this configuration, the rotational strap 344 is arranged toextend from the medial side of the lower wrap 342, over the anteriorthigh and secures to the lateral side or lateral-posterior side of theupper belt member 346.

Besides the rotational strap 344, the derotational strap 350 extendsfrom a lateral side of the lower wrap 342 whereat a lower end 352secures to the lower wrap 342, crossing over the rotational strap as itis directed toward the medial side of the thigh, about the lateral waistand securing to the upper belt member 346 and secured to a pluralitylocations on the upper belt member. As shown, the derotational strap 350has an upper end 354 securing over the hip above the other leg.According to this configuration, the hip orthosis provides internal andexternal rotation control.

FIGS. 27 and 28 exemplify a strut assembly 360 for use with the hiporthosis for connection to the upper and lower wraps in the embodimentsdisclosed herein. The frame 360 includes a strut 362 extending betweenan upper frame 364 and a lower connection 368 to the lower wrap 226. Thelower connection 368 may secure to the lower wrap 226 to an anchor suchas the anchor 266 disclosed with the embodiment of FIGS. 17 and 18whereby a pin or button 374 secures within a slot 368 defined by thelower connection.

The strut 362 has a pivot point 366 within upper frame 364, and theupper end of the strut 362 can slidably engage within a recess or area370 defined within the upper frame 364 to accommodate movement of theuser. The strut 362 may be rigid or substantially rigid to provide foradditional thigh support. As shown in FIG. 9A, the strut 362 may carry atrochanter pad to urge against the trochanter.

The frame 360 may be configured to be attachable and detachable to thehip orthosis embodiments described herein. The garment may includepockets to receive the upper frame, or the upper frame may be attachedby hook and loop fasteners. The upper frame may be flexible toaccommodate the shape of the hip of the user. The strut may reduce orprevent adduction and provides more rigidity to the orthosis to avoidthe risk of dislocation.

FIG. 29 shows an embodiment of a length adjustment assembly for thetensioning device or cable 400. The handle 402 is flexible and defines apocket 408. The embodiment includes a retainer 404 arranged for wrappingexcess or an undesired length 406 of the cable 400 thereabout. Theretainer 404 may include grooves or channels 410 arranged to hold thecable 400. The pocket 408 is sized and configured to accommodate theretainer 404 and excess length 406.

The embodiments of FIGS. 30-35 are directed to an embodiment of a hiporthosis arranged to maintain an upper leg positioned correctlyregarding a trunk during use.

In reference to the embodiment of FIG. 30, the hip orthosis 510 includesa pelvic support 512, a trochanter support 514 and a lower support 516.The pelvic support 512 is arranged for placement at or near the pelvisof the wearer, whereas the trochanter support 514 is arranged forplacement at or near the trochanter of the femur opposite the femoralhead. The lower support 16 is preferably arranged near and above theknee of the wearer. The pelvic, trochanter and lower supports 512, 514,516 are connected to one another by a strut assembly comprising at leastupper and lower struts 518, 520.

The strut assembly comprises a leaf spring from, for instance, metal orplastic. Due to the resiliency of the strut assembly, the hip orthosiscan exert a force and/or a moment on the upper leg, which makes theupper leg abduct, viewed from the front side of the person, preferablyindependently of the position of the upper leg regarding the waist ortrunk. The wearer has more freedom of movement, since the upper leg canpreferably move in all directions.

The upper strut 518 has a first end slidably connected to the pelvicsupport 512 by a slot formed by the upper strut 518 and a fastener 524extending through and securing against the pelvic support 512 and theupper strut 518. By loosening the fastener 524 from the pelvic support512, the pelvic support 512 can be slidably adjusted along the length ofthe upper strut 518 to accommodate the wearer's size. At least one strap526 secures through slots 527 formed along the pelvic support, and issized and configured to extend around the trunk, waist or pelvis of thewearer to anchor the hip orthosis at an upper end of the wearer's leg.

In referring to FIGS. 31A-32, a second end of the upper strut 518 ispivotally connected to a first end of the lower strut 520 by a hinge528. The hinge 528 has a plate 558 secured to an outer surface of theupper strut 518 and permits the lower strut 520 to pivot away from theouter surface of the upper strut 518. Both the upper and lower strutsare preferably resilient bars or plates, and are flexible and resilientso they return to a predetermined shape after they are bent.

A strut adjustment or pivot mechanism 535 is secured to the second endof the upper strut 518, and to the first end of the lower strut 520. Thepivot mechanism 535 includes a dial 536 and a pin 538 connected to thedial 536. A first end of the pin 538 is coupled to the upper strut 518by a pin mount 560, and a second end extends through an opening formedthrough the lower strut 520 to engage the dial 536 that rests upon anouter surface of the lower strut 520. A cover plate 66 may be includedto cover at least part of the pin 538 located between the upper andlower struts 518, 520.

FIG. 33 depicts rotation of the dial 536 that urges the pivoting of thelower strut 520 relative to the lower strut 518. This arrangement isadvantageous in that the wearer can adjust the force exerted by thestrut assembly on the trochanter via the trochanter support 514 to urgethe femoral head into the hip socket. The dial 536 may include indicia,which would allow the wearer to have an understanding how much force toexert onto the hip joint.

The wearer may in an initial fitting set the lower strut 520 so itpivots significantly away from the upper strut 518, and then rotate thedial so the lower strut 520 is drawn toward the upper strut 518 to exertmore pressure on the trochanter. The dial may be coupled to a gearsystem that provides mechanical advantage to enable easier adjustmentand locking of the dial as it is adjusted.

The trochanter support 514 is pivotally and rotatably secured to theinner surface of the upper strut 518 by a swivel 568 and hinge 530. Thisarrangement permits the trochanter support 514 to adjust to the specificanatomy of the wearer and to adapt to movement of the wearer's leg.

A pressure adjustment mechanism 531 is secured to the upper strut 518and preferably located between the pin 538 and the hinge 528. Thepressure mechanism 531 is adapted to urge linear movement of thetrochanter support 514 relative to the inner surface of the upper strut518.

The pressure mechanism 531 includes a dial 532 and a pin 534. The dial532 is on the outer surface of the upper strut 518, and the pin 534extends between the dial 532 and a pin mount 537 on or part of theswivel 568. The lower strut 520 may include a slot 539 enabling the pin534 at least partly through when the trochanter support 514 is fullydrawn toward the upper strut 518.

As shown in FIG. 34, rotation of the dial 532 causes the trochantersupport 514 to linearly travel relative to the inner surface of theupper strut 518. This allows for fine adjustment of the pressure of thetrochanter support 514 without further adjusting the upper and lowerstruts 518, 520 relative to one another. The trochanter support 514 mayinclude padding 562 to provide more compression as the trochantersupport 514 is adjusted against the wearer.

A cover 564 is used to cover both portions of the pressure mechanism 531and the pivot mechanism 535 when they are not being used for adjustment.Portions of the dial 536 may be exposed from the cover 564 for quickadjustment of the trochanter support 514, whereas the pivot mechanism535 is concealed.

Referring to FIG. 35, the lower support 516 is adjustably secured to thelower strut 520 by a sleeve 542 engaging one of apertures 540 formed bythe lower support 516. The apertures 540 are formed along the length ofthe lower strut 520, and the sleeve 542 defines an adjustment device 544that engages one of the apertures 540. The adjustment device 544includes a flexible tab 546 having a head 548 biased toward the lowerstrut to flexibly engage one of the apertures 540. The adjustment device544 allows for sliding the lower support 516 along the second end of thelower strut 520 to adjust the position of the lower support 516 to thelength of the wearer's leg.

The lower support 516 is rotatably and pivotally adjustably secured tothe sleeve 542. A pivot mount 552 secures to the lower support 516 by apivot pin 556 and a hinge 554 attaches to the lower support 516 via thepivot mount 552. A strap 550 secures to the lower support 516 tocircumferentially secure to the lower leg of the wearer.

In any of the embodiments described may include means to allow for quickremoval of the garment if the user desires its removal, such as using arestroom. A zipper may be provided to enable opening the opening of thegarment to facilitate removal or as an opening for male users.

The garment may include various sections including silicone on the innersurface to resist movement of the garment on the body of the user. Thesesections may include the waist portion of the garment and at the lowerportion over the thigh. When added with the tension from the tensioningsystem, the silicone and the tension of the garment tightly secures thegarment to the body of the user.

The garment may be used in combination with various means for therapyincluding cold or hot therapy, such as at the trochanter pad, or variousforms of electrotherapy including NMES, TENS, PEMF and heat therapy.

The embodiments described provide compression, skin protection, sealing,load transfer (compression/rotation), and reduction in pelvis drop andstability. The garment provides compression for those users havingsuperior or lateral osteoarthritis of the hip. Compression at the hip byapplying force to the femoral head moves the point of contact, or may beplacing a counter force on to the femur to reduce the load on the hipsocket. Compression of the pelvis may also assist hip muscles to relaxand reduce muscle pain.

Sealing of the labrum is helpful by placing pressure on the greatertrochanter by the trochanter pad and assisting the labrum to seal theinternal pressure of the joint. The main function of the acetabularlabrum improves hip joint stability by deepening the hip socket byproviding it with extra structural support, and partially sealing thejoint to create a negative intra-articular pressure which contracts anydistractive or pulling-apart forces. The second function of theacetabular labrum increases joint congruity. By placing pressure on thelabrum, the femoral head may get pulled into the socket and moved awayfrom the affected osteoarthritis area of the joint.

The exorotation strap may provide pain relief when the hip joint isexternally rotated. By rotating the femoral head, either internally orexternally, sealing of the labrum may occur. Correcting the posture ofthe muscles placed in a more normal position may assist reduction ofpelvis drop and reduce muscle pain. By stabilizing the hip, pain may bereduced since it is placed in a more correct position. Variousembodiments of the garment may be formed from a slippery elasticmaterial, such as a spandex, which assists in compressing against thebody of the user and reduces the possibility of irritation.

Referring to the embodiment of FIG. 36, features of the embodimentsdescribed herein may be combined in an orthopedic device 600 arranged toaid in hip arthroscopy procedures by distracting the hip joint to allowentry of the arthroscope. The orthopedic device may serve to alleviatepaid arising from indications such as femoral acetabular impingement.

The orthopedic device 600 includes a belt assembly 602 with tensioningdevice 608 that may be arranged similarly to the first and second beltmembers 202, 204, and tensioning devices 214 of the orthopedic device200. The tensioning device 608 may be spread out so the upper tensioningdevices adjust compression in the lumbar region while the lowertensioning devices apply pressure in the trochanter region. The lumbarcompression system delivers active vertebral offloading and a bettergrip of patient's hips. An exorotation strap 604 with a tensioningdevice 606 with may likewise be provided similarly to the exorotationstrap 217 and the tensioning device 220. The exorotation strap 604 maysecure to a lower strap 622 that may be similar to the lower strap 226.Alternatively, the exorotation strap 604 may strap to the lower wrapwith a buckle that enables the user to open the buckle for removal orloosening of the exorotation strap. A known buckle that may be used isdescribed in U.S. Pat. No. 7,198,610, granted on Apr. 3, 2007, andincorporated herein by reference in its entirety.

The orthopedic device 600 is preferably without a garment, but rather itincludes a hip orthosis 610. The hip orthosis is secured to the beltassembly 602 by appropriate means such as a pocket 630 or other fastenermeans such as hook and loop, and to the lower wrap 622. The hip orthosismay be arranged similarly to the hip orthosis described in U.S.application Ser. No. 13/528,032, filed on Jun. 20, 2012, and publishedas U.S. patent application publication 2012/0323154 A1 on Dec. 20, 2012,and incorporated herein in its entirety. The hip orthosis may employ thefeatures in U.S. application Ser. No. 12/353,555, filed on Jan. 14, 2009and published as U.S. patent application publication 2009/0124948 A1 onMay 14, 2009, U.S. Pat. No. 8,172,779, granted on May 8, 2012, U.S. Pat.No. 7,597,672, granted on Oct. 6, 2009, and U.S. Pat. No. 7,198,610,granted on Apr. 3, 2007, incorporated herein by reference in theirentirety.

In referring to FIGS. 36 and 37 illustrate an embodiment of the hiporthosis 610, which incorporates some of the basic functions of the hiporthosis taught in part in U.S. Pat. No. 7,597,672. According to thisembodiment, the hip orthosis 602 includes a hip plate 612 adapted tosecure to the hip of the user and remain in place with the belt assembly602. The orthosis includes a lower thigh cuff 620 adapted to secure tothe thigh of the user and remain in place with the lower wrap 622.

A spring rod 614 connects the hip plate 612 and the lower thigh cuff 620to one another. A lower spring rod support 616 and an upper spring rodsupport 622 engage the spring rod 614. An thigh pad or shell 618slidably engages and is carried by the spring rod 614. The thigh pad orshell 618 may or may not be arranged to rotated relative to the thigh ofa user. The spring rod 614 is pivotally connected to the lower thighcuff 620 at pivot connection 628. The lower thigh cuff 620 may bearranged for height adjustment such that it can slide up and downrelative to the spring rod 614 and snap in place among a plurality ofpredetermined locations.

As for the hip plate 612, the spring rod 614 has an end portion insertedwithin the hip plate 612, and slides side to side relative to the hipplate 612 with the motion restricted by restriction stops 626, andflexion and extension stops 624 limit movements of the hip plate 612 andspring rod 106 relative to one another. The flexion and extensions stops624 and the restriction stops 626 are adjustable on the hip plate 102.

The stops are preassembled for the right hip and range of motion of 0°extension to 70° flexion. If the hip orthosis is fitted for the left hipand the range of motion restriction is adjusted, the restriction stopsand the flexion/extension stops can be placed in the correct location.Two restriction stops, one flexion stop and one extension stop, arearranged to restrict the range of motion. Guides may be provided on theinside and outside portions of the hip plate for reference, however theresultant flexion and extension angle should be verified to assure thatthe correct is angle is set.

If the desired angle is between 0° and 70°, the restriction stops areplaced in two inner openings (closest to the spring rod). If the desiredangle is between 60° and 90°, the restriction stops are placed in twoouter openings (farthest from the spring rod). The flexion/extensionstops are placed according to indicia on the inside and/or the outsideof the hip plate.

The various straps, wraps and tensioning devices may be trimmed toaccommodate the various size profiles of users. Hook materials, bucklesand other fastening devices may be removably secured to these variouscomponents to permit quick sizing changes. The straps may be oriented indifferent directions, such as the exorotation strap, to allow formodular placement of these straps to allow for extension or flexioncontrol, and internal or external control. Various pads may be removablysecured to frame elements, such as the trochanter pad that can have acutout of inner foam for better fit and comfort around the trochanter.

1. An orthopedic device, comprising: a belt located at an uppermostportion of the orthopedic device corresponding to a pelvic region; alower wrap located at a lowermost portion of the orthopedic device andpositioned about a knee region and extending laterally relative thereto;an exorotation strap extending from a medial or lateral side of theorthopedic device at the lower wrap and extending obliquely by spiralingover a thigh region to a lateral or medial side over a posterior oranterior side and toward the uppermost portion of the orthopedic device,the exorotation strap arranged to extend over a hip region of a user. 2.The orthopedic device of claim 1, wherein the exorotation strap has alower end anchoring to the lower wrap and an upper end connected to thebelt, the lower wrap and the belt resisting rotation by the exorotationstrap.
 3. The orthopedic device of claim 1, wherein the exorotationstrap is adjustable in length.
 4. The orthopedic device of claim 1,wherein the exorotation strap is elastic at least in part.
 5. Theorthopedic device of claim 1, wherein the belt is arranged to extendover the exorotation strap and to compress over the pelvic region of auser.
 6. The orthopedic device of claim 1, further comprising a dosingsystem connected to and configured to permit selective adjustment intension of the exorotation strap.
 7. The orthopedic device of claim 1,further comprising a trochanter pad secured to the belt.
 8. Theorthopedic device of claim 1, further comprising a strut assemblyconnecting to the belt and the lower wrap, the strut assembly includingan elongate strut extending longitudinally between the belt and lowerwrap.
 9. The orthopedic device of claim 8, wherein the strut assemblyincludes an upper frame connected to an upper end of the elongate strut.10. The orthopedic device of claim 9, wherein the upper frame isslidably and rotatably secured to the upper end of the elongate strut.11. The orthopedic device of claim 8, further comprising a trochantersupport secured to the elongate strut below an upper end of the elongatestrut.
 12. The orthopedic device of claim 8, wherein the strut assemblyincludes a lower frame connected to the lower wrap and a lower end ofthe elongate strut.
 13. The orthopedic device of claim 1, furthercomprising a garment having a hip region arranged to circumferentiallyextend over a hip region and thigh of a user, the belt extending over atleast a portion of the garment at an anterior side of the garment. 14.The orthopedic device of claim 1, further comprising a posteriorcompression system having first and second tensioning devices secured toand arranged to extend from opposed sides of a posterior region of thebelt toward an anterior region of the belt, the posterior compressionsystem arranged to produce compression over the posterior side of theorthopedic device.
 15. The orthopedic device of claim 14, wherein theposterior compression system has first and second tensioning setscooperating with the first and second tensioning devices, respectively,the first and second tensioning sets secured to the belt at first andsecond joints, respectively, located on opposed sides of the orthopedicdevice and oriented to extend toward one another toward the posteriorside of the orthopedic device.
 16. The orthopedic device of claim 15,wherein the first and second tensioning sets are arranged to traveltoward one another upon tensioning of the first and second tensioningdevices, and counteract tension exerted by the first and second beltmembers.
 17. The orthopedic device of claim 14, wherein an upper end ofthe exorotation strap anchors to the posterior compression system. 18.An orthopedic device, comprising: a belt located at an uppermost portionof the orthopedic device corresponding to a pelvic region; a lower wraplocated at a lowermost portion of the orthopedic device located about aknee region and extending laterally; a posterior compression systemhaving first and second tensioning devices secured to and arranged toextend from opposed sides of a posterior region of the belt toward ananterior region of the belt, the posterior compression system arrangedto produce compression over the posterior side of the orthopedic device;an exorotation strap extending from a medial or lateral side of theorthopedic device at the lower wrap and extending obliquely by spiralingover a thigh region to a lateral or medial side over a posterior oranterior side and toward the uppermost portion of the orthopedic device,the exorotation strap arranged to extend over a hip region of a user,the exorotation strap having a lower end anchoring to the lower wrap andan upper end connecting to the posterior compression unit, the lowerwrap and the belt resisting rotation by the exorotation strap.
 19. Theorthopedic device of claim 18, wherein the exorotation strap isadjustable in length between the lower and upper ends thereof.
 20. Anorthopedic device, comprising: a belt located at an uppermost portion ofthe orthopedic device corresponding to a pelvic region; a lower wraplocated at a lowermost portion of the orthopedic device located about aknee region and extending laterally; a posterior compression systemhaving first and second tensioning devices secured to and arranged toextend from opposed sides of a posterior region of the belt toward ananterior region of the belt, the posterior compression system arrangedto produce compression over the posterior side of the orthopedic device;an exorotation strap extending from a medial or lateral side of theorthopedic device at the lower wrap and extending obliquely by spiralingover a thigh region to a lateral or medial side over a posterior oranterior side and toward the uppermost portion of the orthopedic device,the exorotation strap having a lower end anchoring to the lower wrap andan upper end connecting to the posterior compression unit, the lowerwrap and the belt resisting rotation by the exorotation strap; a strutassembly connecting to the belt and the lower wrap, the strut assemblyincluding an elongate strut extending longitudinally between the beltand lower wrap.